Abstract

Objective To identify predictors of the severity of agitated behavior during inpatient traumatic brain injury (TBI) rehabilitation. Design Prospective, longitudinal observational study. Setting Inpatient rehabilitation centers. Participants Consecutive patients enrolled between 2008 and 2011, admitted for inpatient rehabilitation after index TBI, who exhibited agitation during their stay (n=555, N=2130). Interventions Not applicable. Main Outcome Measure Daytime Agitated Behavior Scale scores. Results Infection and lower FIM cognitive scores predicted more severe agitation. The medication classes associated with more severe agitation included sodium channel antagonist anticonvulsants, second-generation antipsychotics, and gamma-aminobutyric acid-A anxiolytics/hypnotics. Medication classes associated with less severe agitation included antiasthmatics, statins, and norepinephrine-dopamine-5 hydroxytryptamine (serotonin) agonist stimulants. Conclusions Further support is provided for the importance of careful serial monitoring of both agitation and cognition to provide early indicators of possible beneficial or adverse effects of pharmacologic interventions used for any purpose and for giving careful consideration to the effects of any intervention on underlying cognition when attempting to control agitation. Cognitive functioning was found to predict agitation, medications that have been found in previous studies to enhance cognition were associated with less agitation, and medications that can potentially suppress cognition were associated with more agitation. There could be factors other than the interventions that account for these relations. In addition, the study provides support for treatment of underlying disorders as a possible first step in management of agitation. Although the results of this study cannot be used to draw causal inferences, the associations that were found can be used to generate hypotheses about the most viable interventions that should be tested in future controlled trials.

title = "Predictors of agitated behavior during inpatient rehabilitation for traumatic brain injury presented in part to the American congress of rehabilitation medicine, October 10, 2014, Toronto, ON, Canada.",

abstract = "Objective To identify predictors of the severity of agitated behavior during inpatient traumatic brain injury (TBI) rehabilitation. Design Prospective, longitudinal observational study. Setting Inpatient rehabilitation centers. Participants Consecutive patients enrolled between 2008 and 2011, admitted for inpatient rehabilitation after index TBI, who exhibited agitation during their stay (n=555, N=2130). Interventions Not applicable. Main Outcome Measure Daytime Agitated Behavior Scale scores. Results Infection and lower FIM cognitive scores predicted more severe agitation. The medication classes associated with more severe agitation included sodium channel antagonist anticonvulsants, second-generation antipsychotics, and gamma-aminobutyric acid-A anxiolytics/hypnotics. Medication classes associated with less severe agitation included antiasthmatics, statins, and norepinephrine-dopamine-5 hydroxytryptamine (serotonin) agonist stimulants. Conclusions Further support is provided for the importance of careful serial monitoring of both agitation and cognition to provide early indicators of possible beneficial or adverse effects of pharmacologic interventions used for any purpose and for giving careful consideration to the effects of any intervention on underlying cognition when attempting to control agitation. Cognitive functioning was found to predict agitation, medications that have been found in previous studies to enhance cognition were associated with less agitation, and medications that can potentially suppress cognition were associated with more agitation. There could be factors other than the interventions that account for these relations. In addition, the study provides support for treatment of underlying disorders as a possible first step in management of agitation. Although the results of this study cannot be used to draw causal inferences, the associations that were found can be used to generate hypotheses about the most viable interventions that should be tested in future controlled trials.",

keywords = "Brain injuries, Confusion, Rehabilitation",

author = "Jennifer Bogner and Barrett, {Ryan S.} and Flora Hammond and Horn, {Susan D.} and Corrigan, {John D.} and Joseph Rosenthal and Beaulieu, {Cynthia L.} and Margaret Waszkiewicz and Timothy Shea and Reddin, {Christopher J.} and Nora Cullen and Giuffrida, {Clare G.} and James Young and William Garmoe",

year = "2015",

month = "8",

day = "1",

doi = "10.1016/j.apmr.2015.04.020",

language = "English (US)",

volume = "96",

pages = "S274--S281e4",

journal = "Archives of Physical Medicine and Rehabilitation",

issn = "0003-9993",

publisher = "W.B. Saunders Ltd",

number = "8",

}

TY - JOUR

T1 - Predictors of agitated behavior during inpatient rehabilitation for traumatic brain injury presented in part to the American congress of rehabilitation medicine, October 10, 2014, Toronto, ON, Canada.

AU - Bogner, Jennifer

AU - Barrett, Ryan S.

AU - Hammond, Flora

AU - Horn, Susan D.

AU - Corrigan, John D.

AU - Rosenthal, Joseph

AU - Beaulieu, Cynthia L.

AU - Waszkiewicz, Margaret

AU - Shea, Timothy

AU - Reddin, Christopher J.

AU - Cullen, Nora

AU - Giuffrida, Clare G.

AU - Young, James

AU - Garmoe, William

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Objective To identify predictors of the severity of agitated behavior during inpatient traumatic brain injury (TBI) rehabilitation. Design Prospective, longitudinal observational study. Setting Inpatient rehabilitation centers. Participants Consecutive patients enrolled between 2008 and 2011, admitted for inpatient rehabilitation after index TBI, who exhibited agitation during their stay (n=555, N=2130). Interventions Not applicable. Main Outcome Measure Daytime Agitated Behavior Scale scores. Results Infection and lower FIM cognitive scores predicted more severe agitation. The medication classes associated with more severe agitation included sodium channel antagonist anticonvulsants, second-generation antipsychotics, and gamma-aminobutyric acid-A anxiolytics/hypnotics. Medication classes associated with less severe agitation included antiasthmatics, statins, and norepinephrine-dopamine-5 hydroxytryptamine (serotonin) agonist stimulants. Conclusions Further support is provided for the importance of careful serial monitoring of both agitation and cognition to provide early indicators of possible beneficial or adverse effects of pharmacologic interventions used for any purpose and for giving careful consideration to the effects of any intervention on underlying cognition when attempting to control agitation. Cognitive functioning was found to predict agitation, medications that have been found in previous studies to enhance cognition were associated with less agitation, and medications that can potentially suppress cognition were associated with more agitation. There could be factors other than the interventions that account for these relations. In addition, the study provides support for treatment of underlying disorders as a possible first step in management of agitation. Although the results of this study cannot be used to draw causal inferences, the associations that were found can be used to generate hypotheses about the most viable interventions that should be tested in future controlled trials.

AB - Objective To identify predictors of the severity of agitated behavior during inpatient traumatic brain injury (TBI) rehabilitation. Design Prospective, longitudinal observational study. Setting Inpatient rehabilitation centers. Participants Consecutive patients enrolled between 2008 and 2011, admitted for inpatient rehabilitation after index TBI, who exhibited agitation during their stay (n=555, N=2130). Interventions Not applicable. Main Outcome Measure Daytime Agitated Behavior Scale scores. Results Infection and lower FIM cognitive scores predicted more severe agitation. The medication classes associated with more severe agitation included sodium channel antagonist anticonvulsants, second-generation antipsychotics, and gamma-aminobutyric acid-A anxiolytics/hypnotics. Medication classes associated with less severe agitation included antiasthmatics, statins, and norepinephrine-dopamine-5 hydroxytryptamine (serotonin) agonist stimulants. Conclusions Further support is provided for the importance of careful serial monitoring of both agitation and cognition to provide early indicators of possible beneficial or adverse effects of pharmacologic interventions used for any purpose and for giving careful consideration to the effects of any intervention on underlying cognition when attempting to control agitation. Cognitive functioning was found to predict agitation, medications that have been found in previous studies to enhance cognition were associated with less agitation, and medications that can potentially suppress cognition were associated with more agitation. There could be factors other than the interventions that account for these relations. In addition, the study provides support for treatment of underlying disorders as a possible first step in management of agitation. Although the results of this study cannot be used to draw causal inferences, the associations that were found can be used to generate hypotheses about the most viable interventions that should be tested in future controlled trials.